AIDS Community Care Alternatives Program (ACCAP) Waiver
STATE OF NEW JERSEY - DEPARTMENT OF HUMAN SERVICES
DIVISION OF DISABILITY SERVICES
HOME AND COMMUNITY-BASED SERVICES WAIVER
FOR BLIND OR DISABLED CHILDREN AND ADULTS
COMMUNITY RESOURCES FOR PEOPLE WITH DISABILITIES (CRPD)
BACKGROUNDThis 1915(c) waiver was originally submitted to the Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services) which approved the program with an effective date of March 1, 1987. The waiver was recently approved for another five years, effective March 1, 2006. The administration of the ACCAP waiver was transferred to the Division of Disability Services (DDS) from the Division of Medical Assistance and Health Services (DMAHS) in October 2002. The purpose of the waiver is to help eligible individuals to remain in the community or to return to the community, rather than be cared for in a nursing facility or a hospital setting.
SCOPEThe program serves a maximum of 750 participants at any one time and is statewide.
- Adults must be diagnosed as having AIDS, as must children between the ages of 13 and 18. Children under the age of 13 must have a diagnosis of AIDS or HIV positive.
- Participants must be in need of institutional care and meet, at a minimum, the nursing facility (NF) level of care criteria.
- Individuals who are categorically needy (SSI or Division of Youth and Family Services (DYFS) foster children) or optional categorically needy (Medicaid Only) are served under the program.
- For children, parental income or resources are not considered in the determination of eligibility when applying for ACCAP under the institutional Medicaid program at the County Board of Social Services. For adults applying for ACCAP under the institutional Medicaid program at the County Board of Social Services, the spouse’s income is not considered but the spouse’s resources are considered in the determination of eligibility. However, up to one half of the total resources are protected for use by the spouse.
- Any individual applying for the ACCAP Waiver must be determined disabled by the Social Security Administration (SSA) or by the Disability Review Section of the DMAHS, using SSA disability criteria.
- Individuals must need a minimum of two ACCAP Waiver Services: case management plus another service.
- Any individual applying for the ACCAP waiver in order to obtain private-duty nursing (PDN) services must have a live-in primary caregiver (adult relative or significant other adult) who accepts 24-hour responsibility for that applicant’s health and welfare.
SERVICESACCAP offers all New Jersey Title XIX Medicaid services except nursing facility coverage and personal care assistant (PCA) plus the following waiver services:
- Case management - This is a process in which a public health nurse or medical social worker is responsible for planning, locating, coordinating, and monitoring a group of services designed to meet the individual needs of the person being served. Case management sites are located in home care agencies or Special Child Health Services Units. Case management services, which are provided on a monthly basis, include responsibility for developing the plan of care with the beneficiary/family, with input from the attending physician and provider agencies, and for monitoring the cost of the service package.
- Private-Duty Nursing - This is individual and continuous nursing care, as different from part-time or intermittent care, provided by licensed nurses. Private-duty nursing is limited to a maximum of 16 hours per day per person. It is provided only when there is a live-in primary caregiver (adult relative or significant other adult) who accepts 24-hour responsibility for the health and welfare of the beneficiary. The case manager may request an exception to the live-in primary caregiver requirement from the DDS Regional Representative when the participant requires intravenous therapy on an intermittent basis (usually two to three hours several times a week).
- Personal Care Assistance Services - These are health-related tasks performed by a certified individual in an eligible beneficiary’s home, under the supervision of a registered professional nurse and certified by a physician in accordance with a written plan of care. There is no limitation on the number of hours, as exists in the regular Medicaid program.
- Hospice Care - Services are provided by Medicare-certified hospice agencies and are available to ACCAP beneficiaries on a daily, 24-hour basis. Hospice provides optimum comfort measures (including pain control), support and dignity to an individual certified by an attending physician as terminally ill with a life expectancy of up to six months.
COST LIMITATIONS/REQUIREMENTSTotal program costs are restricted by the number of community care slots each year and by per-person costs. Each individual’s service package must be no more than the net average cost of nursing facility care.
There is no retroactive reimbursement of waiver services prior to program enrollment.
ADMINISTRATIONDDS has responsibility for overall administration of the program. The initial assessment of the need for nursing facility (NF) level of care is completed by professional staff from the Department of Health and Senior Services regional field offices.
An annual review of the participant’s need for NF level of care and the continued need for ACCAP Waiver Services will be conducted by the participant’s assigned case manager.
Regional representatives from the DDS review and approve plans of care initially, and, at a minimum, annually thereafter. Program oversight is provided by the DDS and the DMAHS Quality Assurance Unit.
APPLICATIONApplication for the program can be made to the County Board of Social Services located in the county where the individual resides. The exceptions are Supplemental Security Income (SSI) eligible applicants and case workers for the DYFS who wish to make application on behalf of a foster child. They should contact the DDS Office of Home and Community Services at (609) 292-4800.
FURTHER INFORMATIONInquires can be directed to the DDS Office of Home and Community Services, located in Trenton, telephone number (609) 292-4800 or toll-free at (888) 285-3036. Staff is available to provide technical assistance in the application process and additional information on the program.